- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.39 / $669.25 / $2,498.77
| Professional | | $626.39 | $669.25 | $2,498.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.10 / $761.10 / $858.47
| Professional | | $761.10 | $761.10 | $858.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.13 / $978.14 / $7,637.00
| Professional | | $850.13 | $978.14 | $7,637.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $669.77 / $730.66 / $852.43
| Professional | | $669.77 | $730.66 | $852.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $2,155.00 / $2,155.00
| Facility | | $2,155.00 | $2,155.00 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $621.05 / $761.10 / $1,030.36
| Professional | | $621.05 | $761.10 | $1,030.36 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $810.55 / $2,582.96 / $6,124.00
| Professional | | $810.55 | $2,582.96 | $6,124.00 |